-
CategoryHealthcare
-
No of Jobs1
-
Apply Before09/28/2025
Description
Diagnosis Related Group Clinical Validation Auditor-RN
Elevance Health - Los Angeles, CA
Job Title: Diagnosis Related Group Clinical Validation Auditor-RN
Position: Virtual Auditor
Job Type: Full Time
Pay: $81,852 to $155,088
Shift:
Work Type: Remote
Location
Address:
City: Los Angeles
State: CA
ZIP Code:
Job Responsibilities
- Audit inpatient medical records to ensure clinical documentation supports the conditions and DRGs billed.
- Review Diagnosis Related Group (DRG) paid claims.
- Analyze and audit claims by integrating medical chart coding principles and clinical guidelines.
- Utilize advanced ICD-10 coding expertise and industry knowledge to substantiate audit conclusions.
- Generate audit determinations and formulate detailed audit findings letters using audit tools and workflow systems.
- Maintain accuracy and quality standards established by audit management.
- Identify potential documentation and coding errors, recognizing aberrant coding and documentation patterns.
- Develop process improvement and efficiency recommendations.
Required Skills
Core Skills
- ICD-9/10CM knowledge
- Clinical documentation improvement
- Quality assurance in claims auditing
Preferred Skills
- Registered Health Information Technician (RHIT)
- Registered Health Information Administrator (RHIA)
- Certified Clinical Documentation Specialist (CCDS)
- Certified Documentation Improvement Practitioner (CDIP)
- Certified Professional Coder (CPC)
- Inpatient Coding Credential such as CCS or CIC
- Experience with third-party DRG Coding
- Broad knowledge of medical claims billing and reimbursement policies
Requirements
Experience: Minimum of 10 years in claims auditing, quality assurance, or clinical documentation improvement; at least 5 years with ICD-9/10CM, MS-DRG, AP-DRG, APR-DRG.
Education:
License & Certification:
- Current, active, unrestricted Registered Nurse license
Schedule:
COVID-19 Requirements: Not Specified
Benefits
- Comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401k contribution
Supplemental Pay
- Not specified
Special Notes
- Committed to equal pay opportunities for equal work regardless of gender, race, or protected categories.
Facility Details
Name: Elevance Health
Description: Not Specified
Specialties:
- Not specified
Mission: Not Specified
Job Info
Discipline:
Department:
Status:
Sourcing
Duration:
Experience:
Career Level:
No of Jobs:
1
Apply Before:
09/28/2025
Posted:
06/28/2025
